NPIMap

Organization Active NPI

Tri-State Community Health Center, Inc

Doing business as Tri-State Women's Health Center

  • Federally Qualified Health Center (FQHC)
  • Cumberland, MD
National Provider Identifier
1467401372
Registry record updated May 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TRI-STATE COMMUNITY HEALTH CENTER, INC
Doing business as
Tri-State Women's Health Center
Practice address
12502 Willowbrook Road
Ste 550, 5TH FLR.
Cumberland, MD 21502-6393
Phone
(301) 723-3940
Fax
(301) 723-3941
NPI assigned
May 8, 2006
Last updated
May 6, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sheila J Deshong IX
Title
Cheif Operating Officer
Phone
(301) 678-5187

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

12502 Willowbrook Road
Ste 550, 5TH FLR.
Cumberland, MD 21502-6393

Mailing address

109 Rayloc Dr
Hancock, MD 21750-1518
Phone (301) 678-5187

Other names 1

  • Tri-State Women's Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040219000462 MD Part B Supplier - Clinic/Group Practice 9335057355 Receives reassigned benefits from 18 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cumberland, MD; Hancock, MD
O20051019000147 MD Part A Provider - Federally Qualified Health Center (FQHC) 9335057355 Practice locations: Cumberland, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467401372. Details of each certification follow.

Federally qualified health center certification: CCN 211849

Legal name
TRI-STATE COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 7, 2005
Last certification
Dec 7, 2005
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 18, 1987 in MD
Enrollment address
12502 Willowbrook Rd 550
Cumberland, MD 21502-6594

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Tri-State Community Health Center-Hosp Physicians Practice7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Carolyn Lee Clingerman Individual Corporate DirectorBoard Member Aug 6, 2018
Nancy Forlifer Individual Corporate DirectorBoard Member Jun 6, 2011
Katherine Ann Salesky Individual Corporate DirectorBoard Member Aug 6, 2018
Sheila J Deshong Individual Corporate OfficerCoo Nov 1, 2005
W-2 Managing EmployeeCoo Nov 1, 2005
William Rocks Individual Corporate OfficerBoard Member - Vice President Sep 1, 2008
Tracy Lynn Salvagno Individual Corporate OfficerBoard Member - President Dec 1, 2008 100%
Elen L Ott Individual Corporate DirectorBoard Member Oct 1, 2016
Audrey Lynn Morris Individual Corporate DirectorBoard Member Aug 14, 2014
Savin Ramani Pillai Individual Corporate DirectorBoard Member Apr 2, 2018
Cordelia J Carson Individual Corporate DirectorBoard Member Secretary Oct 7, 2013
Susan B Walter Individual Corporate OfficerCeo Jul 1, 2011 100%
W-2 Managing EmployeeCeo Jul 11, 2011 100%
Satricia a Woodal Individual W-2 Managing EmployeeHR Manager Dec 31, 2013
Richard Strait Individual Corporate OfficerBoard Member - Treasurer Apr 1, 2007

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273104000000",
    "number": "1467401372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 RAYLOC DR",
            "city": "HANCOCK",
            "state": "MD",
            "postal_code": "217501518",
            "telephone_number": "301-678-5187",
            "fax_number": "301-678-5797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12502 WILLOWBROOK ROAD",
            "address_2": "STE 550, 5TH FLR.",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "215026393",
            "telephone_number": "301-723-3940",
            "fax_number": "301-723-3941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2010-05-06",
        "status": "A",
        "authorized_official_last_name": "DESHONG",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHEIF OPERATING OFFICER",
        "authorized_official_telephone_number": "301-678-5187",
        "authorized_official_name_suffix": "IX"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tri-State Women's Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cumberland, MD

Sources for this page

Verify at the official NPI Registry.